Faculty Bibliography

As facial plastic surgery becomes more global, pressures for practices to become commoditized will increase. Commoditized practices are those in which price drives the quality of the product. Franchised surgical practices have also recently increased within the United States and abroad. These are always commoditized by their corporate philosophies. There are better ways to create value than to lower price to compete with a neighboring practice. By establishing a Transcendent Relationship of growth, both the surgeon and the patient are more satisfied with their facial plastic surgical experiences. Key tools helpful in predicting future directions for a practice, the Four Compass Points and the Average Best Patient, will be introduced

PURPOSE: This prospective study aimed to evaluate the use of acoustic rhinometry (AR) in pediatric obstructive sleep apnea (OSA). METHODS: Children with clinically suspected OSA underwent AR measurements followed by attended overnight polysomnography. RESULTS: Of a total of 20 subjects (13 boys, seven girls), 15 (75%) had OSA, defined as apnea-hypopnea index (AHI) greater than or equal to five events per hour of sleep, and five had primary snoring (PS). The mean AHI was 16.79 vs. 1.96 events/h. Positional changes in airway measurement by AR were present in the OSA group, with an average decrease in nasal cavity volume from upright to supine position of 1.53 cm(3) (p = 0.027). These changes were predictive of sleep apnea (r (2) = 0.65, p = 0.035). CONCLUSIONS: This study demonstrates a marked difference between OSA and PS groups during AR measurements of the nasopharynx. Positional airway changes had been previously reported in adults with OSA and further evaluation of the airway function in pediatric OSA is warranted

OBJECTIVES/HYPOTHESIS: Anatomic variants of the jugular bulb (JB) are common; however, abnormalities such as large high riding JB and JB diverticulum (JBD) are uncommon. Rarely, the abnormal JB may erode into the inner ear. The goal of our study is to report a large series of patients with symptomatic JB erosion into the inner ear. STUDY DESIGN: Retrospective review in an academic medical center. METHODS: Eleven patients with JB abnormality eroding into the inner ear were identified on computed tomography (CT) scan of the temporal bone. RESULTS: Age at presentation was from 5 years to 82 years with six males and five females. The large JB or JBD eroded into the vestibular aqueduct (n = 9) or the posterior semicircular canal (n = 4). The official radiology report usually identified the JB abnormality; however, erosion into these structures by the JB was not mentioned in all but one case. All patients were symptomatic with five having conductive hearing loss (CHL) and three complaining of pulsatile tinnitus. Those with pulsatile tinnitus and four of five with CHL had erosion into the vestibular aqueduct. Vestibular evoked myogenic potential (VEMP) findings in three of six patients were consistent with dehiscence of the inner ear. CONCLUSIONS: High riding large JB or JBD can erode into the inner ear and may be associated with CHL and/or pulsatile tinnitus. CT scan is diagnostic and should be examined specifically for these lesions. As patients with pulsatile tinnitus may initially undergo a magnetic resonance imaging scan, identification of JB abnormality should prompt CT scan or VEMP testing to evaluate for inner ear erosion

Sir William Robert Willis Wilde (1815-1876) made many contributions to otology. Perhaps his greatest, and the one least appreciated, was his performing, analyzing, and reporting of the 1851 census of the deaf of Ireland. He is the first to recognize and document genetic deafness as a major cause in early-onset deafness. His census techniques used trained enumerators, and for each family suspected as having a deaf person, a physician was sent who, before obtaining the very detailed family and medical history, was required to obtain an informed consent. Wilde's career is analyzed to show how his previous publications led to his appointment in 1850 as the only Assistant Medical Census Commissioner for the 1851 census.

PURPOSE: To develop a grading system to evaluate the scleral spur visibility and to investigate the association between this and the angle width. METHODS: Sixty healthy normal subjects (33 with open angles and 27 with narrow angles on dark room gonioscopy) underwent anterior segment imaging with the Visante OCT (Carl Zeiss Meditec, Dublin, CA). The anterior chamber angles at 12-o' clock hour positions were imaged and analyzed. The scleral spur at each clock hour position was independently graded by 2 observers. A scleral spur visibility score (SSVS) of 2 denotes clear visibility of the scleral spur. SSVS of 0 and 1 represent undetectable and moderately by visibile scleral spur, respectively. The interobserver agreement of the SSVS was evaluated with kappa statistics. The associations between age, sex, axial length, refraction, angle width [mean anterior chamber angle detection with edge measurement and identification algorithm (ACADEMIA) angle], and the mean SSVS were examined with univariate and multivariate analyses. RESULTS: The mean gonioscopy grades were 3.6 and 0.8 for the open and narrow angle groups, respectively. The interobserver agreement in grading the scleral spur visibility was 0.71. The inferior angle (6:00) had the worst visibility of the scleral spur (SSVS=1.05+/-0.49) whereas the scleral spur of the nasal angle (3:00) showed the best visibility (SSVS=1.66+/-0.46). There were significant differences between SSVS at 6:00 and the other clock hours except for 5:00 and 7:00. The mean SSVS correlated positively with gonioscopy grade, anterior chamber depth, and ACADEMIA angle, and negatively with age. The only significant factor associated with scleral spur visibility was the ACADEMIA angle (P=0.013) after adjustment for other covariates. CONCLUSIONS: The visibility of the scleral spur is an important determinant of the dimension of anterior chamber angle